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NPI Code Detail

MEDICARE: MARY C WALKER COTA/L

MEDICARE: MARY C WALKER COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant2360AZ

General Provider Information

NPI Number : 1356650097
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY C WALKER COTA/L
Provider Business Mailing Address
First Line : 3567 N IRVING ST
Second Line :
City : KINGMAN
State : AZ
Zip : 86409-3121
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2812 SILVER CREEK RD
Second Line :
City : BULLHEAD CITY
State : AZ
Zip : 86442-8309
Country : US
Telephone Number : 928-763-1404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2010
Last Update Date : 09/29/2010

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Directions to “ MARY C WALKER COTA/L” Practice Location

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